Provider Demographics
NPI:1356529390
Name:MALLETT, JANELLE RACHEL (MD)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:RACHEL
Last Name:MALLETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:DEPARTMENT OF DERMATOLOGY
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1956
Mailing Address - Country:US
Mailing Address - Phone:860-679-4600
Mailing Address - Fax:
Practice Address - Street 1:21 SOUTH RD
Practice Address - Street 2:DERMATOLOGY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2482
Practice Address - Country:US
Practice Address - Phone:860-679-4600
Practice Address - Fax:860-679-1248
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT049883207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1356529390Medicaid